Voices - The new rules on agency spending are fait accompli, says Susan Osborne

What happens when politicians go on holiday? NHS Improvement, a merger of Monitor and the Trust Development Authority, appeases the Treasury by producing a quick fix on new rules for agency nursing spend (

An ‘engagement document’ sent to foundation trusts and NHS trust executive teams on August 12 requires responses by August 20 so that the new rules could be implemented in September.

In no way is this an adequate time scale for meaningful consultation. It makes the new rules on agency spending a ‘fait accompli’ with little front line professional input.

Rather than addressing the root causes of staff shortages and providing strategic leadership on the procurement of agency staff, the focus is on introducing a 3% cap on agency spending on nurses, midwives and healthcare assistants. This will result in further unsafe staffing levels across all sectors.

The value of nursing is absent from the new rules. They advocate pharmacists and paramedics undertaking some of the work of nurses and a change in skill mix that will herald the introduction of a band 4 unregistered nurse. This may be a cheaper option, but it will fall to already overstretched registered nurses to provide additional supervision for this role.

NHS Improvement, as a new organisation, needs to demonstrate strategic leadership from the start. Resolving the root causes of spending problems within the NHS requires a true partnership, not just another quick fix.

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